American College of Physicians: Internal Medicine — Doctors for Adults ®


ACP outlines views on quality at Senate roundtable

From the January 1997 ACP Observer, copyright 1997 by the American College of Physicians.

At a "Roundtable on Health Care Quality Management" last month sponsored by two U.S. senators, ACP President Christine K. Cassel, FACP, outlined the College's views on how government standards can guide market forces to improve the quality of U.S. health care.

Although price will likely remain the most important consideration when Americans choose a health plan, Dr. Cassel explained that "it is ACP's belief that we should take steps to encourage health plans to compete on the basis of the quality of care they provide."

She delineated several steps the government can take:

  • Require health plans to disclose more information to help potential enrollees make more informed choices. Examples of this information include accreditation status, the availability of specialists and out-of-network providers, physician disenrollment rates, enrollee cost-sharing requirements and whether the plans give participating physicians any financial incentives.
  • Standardize data and use more accurate performance measures to help consumers compare competing plans. Currently, many "report cards" focus on utilization alone—not outcomes—and are rarely adjusted to reflect differences in the health status of a plan's patients. The data from patient satisfaction surveys, meanwhile, can be manipulated by health plans. And, since each plan uses its own kinds of data, physicians who work for multiple plans face an onerous burden.

    "These defects undermine efforts to evaluate the quality of care provided," Dr. Cassel told the group. "They also reduce physicians' confidence that clinical outcomes can be measured, and that these measurements can be used to improve outcomes."

  • Enact legislation that gives HCFA the authority to contract directly with provider-sponsored organizations to provide Medicare benefits.
  • Increase funding for outcomes research and technology assessment and create a new type of non-profit peer-review organization described by ACP as a "quality improvement foundation." Such an organization could identify and disseminate information to physicians about best practices, monitor quality of care, support outcomes research and educate consumers on issues of medical effectiveness.
  • Promote medical liability reforms, particularly those that assign liability to institutions or organizations that have the ability to implement quality improvement systems.
  • Provide coordinated care, particularly for the elderly and those people with chronic conditions, as a way to ensure Americans receive necessary care. The College recommends that HCFA use case management, make greater use of bundled payments and contract for the care of chronically ill patients.

Dr. Cassel also encouraged the senators not to forget the growing number of Americans who are uninsured, saying the scientific literature shows that uninsured Americans have poorer health outcomes and receive lower quality care than those with insurance.

The roundtable meeting was sponsored by Sens. Bill Frist (R-Tenn.), a cardiac surgeon, and Sen. Joseph I. Lieberman (D-Conn.). It was also attended by Sens. Jim. M. Jeffords (R-Vt.), the new chairman of the Senate Labor and Human Resources committee, and Jay Rockefeller (D-W.Va.). In addition to Dr. Cassel, witnesses included representatives from HCFA, the American Association of Health Plans, AARP, the RAND Corp. and several large corporations that provide health benefits to employees.

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